Ilona is an eight-year-old girl who is an enthusiastic student at the Passaic County Elks CP Center in Clifton, New Jersey. She was born with spinal muscular atrophy, a chronic condition which leaves her with only minimal voluntary control over motor movements. As a result, she cannot walk, swallow or speak, and she requires a breathing tube. A wheelchair provides her with a means of mobility, and a feeding tube and on-going suctioning address her swallowing and breathing problems. A specially designed augmentative communication system enables Ilona to be an active participant in academic and social activities.

Ilona’s augmentative communication system uses the EZ Keys and Talking Screen software programs from Words+, which run on a standard Windows operating system on a regular laptop computer (Ilona’s is a Dell Inspiron 7000). The laptop is also equipped with Words+ MicroCommPac with DECtalk, a speech output accessory which provides voice quality of high intelligibility.

EZ Keys is a text-based computer access program designed for users who have a third-grade reading level or above. Users with a wide range of disabilities find EZ Keys simple to operate and essential to everyday communication. EZ Keys allows the literate user to do everything from typing a letter, to engaging in conversation with a friend, to turning on the TV.

The software comes with a number of time-saving features, including dual word prediction and abbreviation expansion. When the user begins to type a word, EZ Keys displays a table of the six most frequently used words that begin with those letters and scans through the choices. By activating a switch, the user selects the appropriate word fom the display, and EZ Keys instantly types the entire word. In addition, EZ Keys features next word prediction, where the program actually learns the user's word patterns and displays a list of the last six words used in conjunction with the previous word. The word prediction database can contain up to 5,000 words and can be easily modified to include new vocabulary. EZ Keys also recognizes abbreviations for frequently used words and phrases and for instant speech.

Since Ilona cannot type on a regular keyboard or manipulate a mouse, she accesses E-Z Keys through the use of a wobble switch (Prentke Romich). She "types" by utilizing single-switch scanning with an on-screen keyboard. She can choose to use a cross hair scanning method or a radar mouse feature. The cross hair scanning that I observed is a horizontal line that moves up and down the computer screen. When the line goes through a portion of the screen that Ilona wishes to use, she activates the wobble switch with a few fingers and then waits until the cross hair cursor scans across the screen to the specific key that she wants. The radar mouse works in a similar fashion except the radar mouse radiates out from the center of the screen.

Using these two scanning methods, Ilona spells, types, and participates in reading and writing tasks in the classroom. She is able to type personal information and can execute simple computer functions like opening and closing programs and changing fonts and colors. Ilona’s curriculum is scanned into the computer so that she can use E-Z Keys to answer the questions. Her instructional aide connects a flatbed scanner to the laptop, and then takes the worksheets that her classmates are using and runs them through the scanner. Once the document is open on the monitor, Ilona enters her answers using one of the scanning methods. Her aide moves the cursor from question to question to expedite the process. This arrangement enables Ilona to complete the same written work as her peers.

While Ilona uses EZ Keys to complete her schoolwork, she uses Talking Screen for Windows when she wants to communicate. Talking Screen is a pictographic communication software package that uses Mayer-Johnson symbols and pictures to create a series of communication boards on a computer monitor. When a picture is selected, the computer speaks aloud the stored message. Page layouts can be customized using real photos and video of family and friends. DECtalk or recorded speech plus various access methods are available, including single switch scanning . The software includes a word processing page for writing documents and a magnification feature for users who are visually impaired.

Ilona has several communication boards in Talking Screen which she accesses through single switch scanning - theme boards which she uses during the day to participate in circle time, math and reading, and a page which is entitled "My Special Page." This page contains messages related to her physical needs and personal preferences, such as "I need to be suctioned," "I need to be changed," "I want to play a game," and "I want to watch TV." The messages "yes," "no," and a link to "My Special Page" appear on every board so that she can access those messages quickly.

Ilona has social pages that enable her to play card games such as Uno. She was able to play Candyland with her speech therapist while I was visiting. She also has stored in the system stories she can read to her siblings. The communication page that impressed me the most was Ilona’s synagogue page which contained religious symbols and prayers in Hebrew. Ilona’s father had created the Hebrew page for her.

Unlike most communication boards, Ilona’s picture symbols do not include any food vocabulary. Her speech therapist explained that since Ilona is fed with a feeding tube and does not make food selections, there was no point in taking up valuable communication board space with irrelevant words.

Through the use of her augcomm system, Ilona can experience typical life activities. She can have play dates and help her sister with her homework, as well as have fights with her sibling. Ilona’s mother feels that the communication system has changed their lives. In fact, she says, "There are MAJOR ISSUES if there is no computer for Ilona to use." This prompted me to ask what they do if her system breaks down. Her family has solved this problem by installing a back-up copy of EZ Keys and Talking Screen on her father’s laptop computer.

Ilona has been a student at the Passaic County Elks CP Center since she was four years old and has had the support of speech therapist Laura Hoag since that time. Laura’s careful attention to Ilona’s specific vocabulary needs and her provision of on-going training has clearly paid off. Ilona has learned to use this system for writing and communication, in school and at home. Her mother reports that she "uses her computer all the time. The only time she does not use her computer is when she is sleeping."

Ilona was simply amazing to watch. She constantly interacted with her teachers, her speech therapist, her nurse, her mother, and the other children during my visit. A current goal for Ilona is to move beyond responding to others’ questions to initiating conversations spontaneously. Another goal is improve her reading skills so she can learn to use the internet. As she continues to progress, she will be able to expand her communication skills through the use of the READER feature in EZ Keys. This will allow Ilona to prepare reports or longer communiqués such as word processing files that can be read out loud with the click of a single switch. This will expand her world even more by enabling her to participate more extensively in social conversations and to make presentations to her class like other third graders.

wobble switch